Bust High Drug Costs

A lawyer might say it’s a conflict of interest for a person prescribing medications to also sell them, but it’s a fact of life in veterinary medicine. And it’s a good thing they do. Most human pharmacies don’t stock veterinary medications, so if the veterinarian didn’t carry the drug it wouldn’t be immediately available at the time the animal is treated.

However, many owners and trainers aren’t happy with this system, citing two general complaints:

1) A veterinarian may refuse to sell or order a medication without seeing the horse first, even if it’s a refill of a medication that has been in use, or won’t dispense a drug the owner/trainer considers a “routine” drug to just have on hand.

2) The vet may charge more for the medication than what the owner would pay somewhere else.

Veterinary service for an illness or injury can put a strain on many owners’ budgets, and when the treatment also involves long-term medication the total can be staggering. Every horse owner realizes illness and injury are facts of life, and rational people certainly expect to pay for professional services, but drug costs are another matter. Are there ways to save money'

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Dispensing MedicationsMedications used in horses fall into three general categories:

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 OTC (over the counter),  Veterinary use by prescription,  Extra-label use (not approved for use in the horse).

The most common example of an OTC medication is a dewormer. Vaccinations are also sold OTC in most states. Many antibiotics (e.g. injectable penicillin), injectable vitamins, intravenous fluids, electrolyte-replacement solutions and even hormone implants for cattle are also widely available OTC. The FDA determines which drugs can be labeled OTC or prescription-only, based on whether or not the drug can be labeled with “adequate directions for use” that will enable the average layperson to use it safely.

When a horse is treated with a drug labeled “federal law restricts this drug to use by or on the order of a licensed veterinarian,” making it a prescription drug, or with a drug that isn’t approved for use in the horse, making it extra-label use, the FDA states that a veterinarian may only use or dispense the drug “where a valid veterinarian-client-patient relationship exists.”

This means that you must be an established client of the practice and that the specific horse for which the medication is intended must have been diagnosed/examined by the veterinarian dispensing the drug.

In other words, if you call your vet and say you want to pick up a bottle of acepromazine because you have a new horse that won’t stand still to be clipped, or you want a bottle of bute pills because you’re “out” of them, the vet can — and by law technically should — refuse to sell it to you. Some vets even interpret the law to mean that, if you have a horse he or she previously diagnosed with chronic arthritis, the horse should be examined every time you request another bottle of bute.

Obviously, most vets exercise discretion in how strictly they interpret these guidelines, especially if they want to keep larger clients. Most owners also understand the value of having their horses re-evaluated to see if a change in a treatment program is in order. However, don’t expect to walk into the office of a veterinarian you don’t regularly use and buy medications.

Once you’re an established client, the details of what will or will not be dispensed without a call and how often an animal with a chronic condition will have to be re-examined can be hashed out. If you don’t like the veterinarian’s decision, you’ll have to find a new one.

Drug PricesIt used to be that when a new drug was released you expected the price to be high while the patent was in force, allowing the manufacturer to recover its development costs. Once it expired, the price would drop as other companies started making it. We’ve seen the system work for many drugs, as prices for medicines like gentamicin and flunixin drop with a generic form. However, it’s another story if your horse needs a human drug, like pergolide for Cushing’s disease, or the newer veterinary drugs like Gastrogard or Marquis, which are quite costly.

We understand hefty funds are required for research and development, but a lot of money goes into marketing, too. Drug-company representatives are the new generation of door-to-door salesmen, descending on medical professionals in droves, plying them with pens, pads and samples in exchange for a chance to push their drugs. Incentives are often offered for buying in bulk, meaning, of course, that brand will be dispensed, even when an alternative that may be less expensive for the client.

Drug companies also spend more than ever on glossy magazine ads in hopes that owners will pressure their vets for a specific prescription drug or vaccine. Mostly, however, the ads simply annoy veterinarians who then have to deal with off-the-wall questions and requests from some clients.

But what really rubs salt in the wound is when prices for old stand-bys like furosemide, which likely paid off research-and-development costs long ago, have had hikes that were several times the rate of inflation. Of course, drug companies will quickly counter that established drugs also help pay for the development of new drugs and that marketing is a necessity to be sure professionals and consumers are aware of a new drug’s existence.

Of legitimate concern to us is the price of the medications you buy from the vet. Since the vet both prescribes and sells the drug, the potential for abuse both by overprescription of medications and overcharging for them is obvious.

By and large, most vets don’t overprescribe medication, although valid questions surround specific issues such as overdiagnosis of difficult-to-confirm conditions like EPM or gastric ulcers that then call for long periods of treatment with expensive medications. In these cases, the owner/caretaker should bear some responsibility as an informed health-care consumer and seek a second opinion. If your vet objects, you may have reason to wonder if there’s a monetary objective at work.

Price gouging has been addressed in many Canadian provinces, and various solutions have been implemented, from having a central warehouse for veterinary drugs where both owners and vets buy them at the same set price to systems that focus on compensating the vet for his or her time while drugs are purchased strictly at cost or cost plus a small handling fee.

No such consumer safeguards are available to Americans, and the fact remains that many U.S. veterinary practices realize 30% or more of their gross income from medication sales. This may actually help keep office-call fees down, and most vets do put a ceiling on their drug markups, especially the higher-priced items, with profit rarely more than 20%.

We believe this markup range is fair, but what do you do if you know for certain the markup is exorbitant or financial considerations dictate you find the lowest pricing possible'

Your veterinarian should write you a prescription as part of his or her servi ce. You may even find a workable solution to purchase the first dose from your veterinarian and get a prescription for the refills.

However, we’ve heard stories about vets or office personnel who get angry at people who want to buy medications elsewhere, claiming “they need to eat, too,” even flat-out refusing to write a prescription and telling clients they’ll no longer care for their animals if they don’t buy their drugs from the vet. Can a veterinarian do this legally' No.

The vet is obligated to provide the care of your animal once he accepts the responsibility for its care. They can’t insist you buy medications only from them. Of course, your options for recourse may be limited. Telling the vet you know this isn’t legal may help, although you definitely risk ill will. Your best bet is to find another veterinarian.

Prescription In HandOnce you have a prescription, what do you do'

Your Rite-Aid or Pharmor likely can’t fill it, unless it’s for a human drug in a human-dose form. Even if the pharmacy agrees to order it for you, odds are you’ll pay more for it due to the small order. So, ordering Adequan through CVS won’t help.

You can’t take your prescription to another vet clinic. They can’t fill it because there’s no valid veterinarian-client-patient relationship. Vet clinics can’t function like drug stores.

Purchasing directly from manufacturers doesn’t usually work either, as they require you to buy in bulk, as do large veterinary-supply houses that service veterinarians.

You need a mail-order/Internet veterinary pharmacy. Internet prices are often lower, but a professional-looking web site is no guarantee you’re dealing with a legitimate company (see sidebar at end of story). If your prescription is for a human drug, check prices from your local supermarket pharmacy and a human Internet pharmacy. Our chart lists several pharmacies and charges for some commonly ordered items.

Generics And CompoundsGeneric versions of brand-name drugs offer considerable price reductions. USP-approved generics are guaranteed to contain the same amount of active drug as an identically labeled brand name.

With most injectables, there is little-to-no difference between the products, so a generic furosemide instead of Lasix, or flunixin instead of Banamine, will get you the same results. You can’t be as sure, though, with oral drugs.

With oral drugs, the difference usually isn’t the amount of active drug, but how quickly the drug is absorbed. If it breaks down too slowly, or too quickly, it may not be available at the sites of absorption in the same concentrations, which can affect results. Keep this in mind if a generic doesn’t seem to be working.

It’s also becoming increasingly popular to compound drugs — or combine ingredients — in an attempt to duplicate brand names. A popular compound is trimethoprim-sulfa combinations for EPM.

Some people also try compounding to get their horse’s medications in a more convenient form (liquid or paste instead of powder/pill), or just one that tastes better. However, there’s a lot more to correct compounding than you might think.

The bases and flavorings used in a compounded drug can change how easily it’s absorbed or even bind to the drug to make it non-bioavailable. Your compounding pharmacy should have an on-staff pharmacist knowledgeable about the chemistry of such drug interactions and compounding principles, preferably with specific training in compounding.

If you’re compounding only to get a preparation that is easier to administer, consider taking the little extra time to do it yourself by crushing your medication right before giving it and mixing it in a liquid carrier.?? This way you will know for sure the proper dose is in there and won’t have to worry about any loss of potency when giving the medication immediately.?? Call a pharmacy to check for carrier compatibility.

Compounded drug formulations, even if prepared using brand name products, aren’t subject to the same tests of purity and potency as prepackaged drugs.?? Merial, the makers of Gastroguard, reports that in 10 compounded Gastroguard generic look-alikes tested, omeprazole content (the active ingredient) was from 6 to 74% of that claimed.

If the results you obtain from your compounded drug formulation aren’t those expected, the pharmacy should be asked to provide a certificate of analysis for the finished product.?? This may not always be available, especially in the case of products that are made strictly for individual animals rather than in batches.??

Bottom LineYour best, most convenient source for drugs is your vet, and he or she deserves a fair markup to cover handling costs and make a small profit. Most vets are fair in their pricing, but you can ask for a prescription if you want. However, it’s ridiculous to expect to request a prescription and have it handed out no questions asked, any more than you can do that with your own physician.

If you choose not to buy from your veterinarian, after an examination he or she should give you a prescription with no additional fee for writing it. Several companies can fill your prescription for brand-name veterinary drugs.

Check catalogs that carry vaccines and the like. You may find a section in the catalog listing medications available “by prescription only,” and you can call for availability of your drug. Always check to make sure they are licensed and properly staffed, especially if you request generics or compounded drugs.

As for across-the-border purchases, that’s a personal decision. It’s currently legal to purchase up to a 90-day supply of drugs for personal use and bring it into the United States. Whether or not you need a prescription is up to the country of origin. You’ll have to do the searching yourself to locate sources.